Healthcare Provider Details

I. General information

NPI: 1497529598
Provider Name (Legal Business Name): ERIC D. HOVERSTAD DDS PLLC II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 SPRINGBROOK AVE STE 110
CLAYTON NC
27520-5311
US

IV. Provider business mailing address

3809 COMPUTER DR STE 101
RALEIGH NC
27609-6518
US

V. Phone/Fax

Practice location:
  • Phone: 919-585-7646
  • Fax:
Mailing address:
  • Phone: 984-258-2727
  • Fax: 919-844-2856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIC HOVERSTAD
Title or Position: MANAGING MEMBER
Credential:
Phone: 919-247-8404